Association of unmet discharge needs on readmission or mortality among acute respiratory failure survivors during the COVID-19 pandemic: The Addressing Post-Intensive Care Syndrome (APICS-COVID) multicenter prospective cohort study
9 affiliations
- 1Department of Hospital Medicine, Intermountain Medical Center, Murray, Utah, United States of America
- 2Department of Medicine, University of Utah, Salt Lake City, Utah, United States of America
- 3Department of Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States of America
- 4Outcomes After Critical Illness and Surgery (OACIS) Group, and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
- 5Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- 6Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- 7Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States of America
- 8Section of Pulmonary and Critical Care Medicine, George E Wahlen VA Medical Center, Salt Lake City, Utah, United States of America
- 9Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
Abstract
Background: Survivors of acute respiratory failure (ARF) often face long-term impairments known as Post-Intensive Care Syndrome. These impairments, coupled with fragmented healthcare, contribute to high rates of readmission and mortality. The COVID-19 pandemic challenged healthcare systems, providing an important opportunity to evaluate healthcare fragmentation before and during the pandemic. Methods: From December 2020 to July 2022, this prospective multicenter study (APICS-COVID) enrolled ARF survivors discharged home from acute care hospitalization. The primary exposure was unmet healthcare needs within 1−4 weeks post-discharge and the primary composite outcome was 3-month readmission and mortality. We additionally compared unmet healthcare needs in this study versus a predominately pre-pandemic cohort from an identical study protocol (APICS-01). Results: Of 201 patients enrolled, 94% had at least one unmet healthcare need. The median (IQR) number of healthcare needs upon discharge was 18 (11–25) and the median proportion of unmet healthcare needs was 26% (17−36%). Follow-up appointments were the most frequent unmet need. Higher vs. lower unmet healthcare needs were not significantly associated with 3-month readmission or mortality (aRR 0.61, p = 0.22). Compared to the APICS-01 cohort, the frequency of 3-month readmission/mortality was lower (14% vs. 29%, p = 0.26), despite higher unmet needs in the APICS-COVID cohort (26% vs. 16%, p < 0.001). Conclusions: Across six US academic hospitals during the COVID-19 pandemic, we did not detect a significant association between higher and lower unmet healthcare needs and 3-month readmission or mortality. Compared to APICS-01, unmet follow-up appointments increased but readmission and mortality decreased. Home health services, durable medical equipment, and medications remained robust during pandemic conditions.
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BibTeX
@article{carmichael2026association,
title = {{Association of unmet discharge needs on readmission or mortality among acute respiratory failure survivors during the COVID-19 pandemic: The Addressing Post-Intensive Care Syndrome (APICS-COVID) multicenter prospective cohort study}},
author = {Harris L. Carmichael and Danielle Groat and Victor D. Dinglas and Somnath Bose and Mustafa Mir Kasimov and James C. Jackson and Naga Preethi Kadiri and Maria Isabel Trejo-Zambrano and Carla M. Sevin and Tom Greene and Dale M. Needham and Samuel M. Brown and for the APICS-COVID Study Team},
journal = {PLOS One},
year = {2026},
month = nov,
doi = {10.1371/journal.pone.0361770},
url = {https://doi.org/10.1371/journal.pone.0361770},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of unmet discharge needs on readmission or mortality among acute respiratory failure survivors during the COVID-19 pandemic: The Addressing Post-Intensive Care Syndrome (APICS-COVID) multicenter prospective cohort study
AU - Harris L. Carmichael
AU - Danielle Groat
AU - Victor D. Dinglas
AU - Somnath Bose
AU - Mustafa Mir Kasimov
AU - James C. Jackson
AU - Naga Preethi Kadiri
AU - Maria Isabel Trejo-Zambrano
AU - Carla M. Sevin
AU - Tom Greene
AU - Dale M. Needham
AU - Samuel M. Brown
AU - for the APICS-COVID Study Team
PY - 2026
DA - 2026/11/06
JO - PLOS One
DO - 10.1371/journal.pone.0361770
UR - https://doi.org/10.1371/journal.pone.0361770
AB - Background: Survivors of acute respiratory failure (ARF) often face long-term impairments known as Post-Intensive Care Syndrome. These impairments, coupled with fragmented healthcare, contribute to high rates of readmission and mortality. The COVID-19 pandemic challenged healthcare systems, providing an important opportunity to evaluate healthcare fragmentation before and during the pandemic. Methods: From December 2020 to July 2022, this prospective multicenter study (APICS-COVID) enrolled ARF survivors discharged home from acute care hospitalization. The primary exposure was unmet healthcare needs within 1−4 weeks post-discharge and the primary composite outcome was 3-month readmission and mortality. We additionally compared unmet healthcare needs in this study versus a predominately pre-pandemic cohort from an identical study protocol (APICS-01). Results: Of 201 patients enrolled, 94% had at least one unmet healthcare need. The median (IQR) number of healthcare needs upon discharge was 18 (11–25) and the median proportion of unmet healthcare needs was 26% (17−36%). Follow-up appointments were the most frequent unmet need. Higher vs. lower unmet healthcare needs were not significantly associated with 3-month readmission or mortality (aRR 0.61, p = 0.22). Compared to the APICS-01 cohort, the frequency of 3-month readmission/mortality was lower (14% vs. 29%, p = 0.26), despite higher unmet needs in the APICS-COVID cohort (26% vs. 16%, p < 0.001). Conclusions: Across six US academic hospitals during the COVID-19 pandemic, we did not detect a significant association between higher and lower unmet healthcare needs and 3-month readmission or mortality. Compared to APICS-01, unmet follow-up appointments increased but readmission and mortality decreased. Home health services, durable medical equipment, and medications remained robust during pandemic conditions.
SN - 1932-6203
ER -